Parathyroid tumor
What is a parathyroid tumor?
Parathyroid tumors are lumps in the parathyroid glands; small endocrine glands located in the neck responsible for regulating the body’s calcium levels through the production of parathyroid hormone (PTH). While the majority of these tumors are benign, known as parathyroid adenomas, a small fraction can be cancerous, referred to as parathyroid carcinoma.
Parathyroid cancer is considered a rare oncologic pathology. In the structure of other oncologic diseases, the share of this disease accounts for up to 2%. Usually, the neoplasm is diagnosed in people over 50 years old.
If unchanged cells of the gland are transformed, we speak of primary cancer. In case of malignization of a benign mass (adenoma), the cancer is considered secondary.
Parathyroid gland tumors are characterized by invasive but slow growth. Diagnosing this pathology in the early stages of development contributes to a favorable prognosis.
Types of Parathyroid Tumors
- Parathyroid Adenomas: Benign tumors that are the most common cause of primary hyperparathyroidism.
- Parathyroid Carcinoma: Rare and more aggressive, these cancerous tumors can lead to severe calcium imbalance and require prompt treatment.
Based on the degree of prevalence of the pathological process, the following stages of parathyroid cancer development are distinguished:
- First – the tumor is located in the structure of one of the parathyroid glands.
- Second – the neoplasm increases in size, and invasion into the thyroid tissue is possible.
- Third – the cancerous tumor infiltrates into the surrounding tissues. Regional lymph nodes may be involved.
- Fourth – not only nearby organs are involved in the pathologic process, but also distant organs.
Symptoms
In the early stages, parathyroid cancer may be asymptomatic. However, most tumors are hormone-producing. An increase in the level of parathormone in the blood is accompanied by vivid clinical manifestations, which contributes to diagnosing the disease in the early stages of development. Signs of parathyroid cancer can be as follows:
- Single or multiple small nodular masses on the neck;
- a feeling of pressure in the neck area;
- dysphonia;
- irritability;
- weakness;
- thirst;
- decreased appetite;
- abdominal pain;
- increased urination;
- stool irregularities;
- nausea;
- lack of appetite;
- arterial hypertension.
In advanced stages, the tumor can grow to a large size, compress structures, and change the appearance of the neck. Prolonged hypercalcemia provokes the development of urolithiasis, peptic ulcer, pancreatitis, gallstone disease, and heart problems. Changes in the nervous system lead to depression and psychosis.
In advanced cancer, there are swallowing disorders, voice problems, laryngeal paresis, and enlarged neck and subclavian lymph nodes.
Reasons
Parathyroid cancer develops due to malignant transformation of the gland epithelium or adenomatous nodule. The following factors may be the causes of malignization:
- hereditary predisposition;
- mutations in the cyclin D1 gene;
- multiple endocrine neoplasia syndrome;
- renal failure;
- Irradiation of neck tissue in the treatment of other tumors;
- chronic intoxication with heavy metal salts;
- calcium deficiency in the body;
- iodine deficiency;
- irrational diet.
Diagnosis
If parathyroid cancer is suspected, a comprehensive examination is carried out. The first stage is laboratory diagnostics. Assign a general blood and urine analysis, calcium and phosphate levels determination, and parathormone analysis. Visualization diagnostic procedures (ultrasound, CT, MRI) allow us to assess the affected gland’s location and size and the presence of tumor invasion into the surrounding tissues. Based on the results of contrast-enhanced MRI, it is possible to make preliminary conclusions about the nature of the neoplasm.
Fine-needle aspiration biopsy allows the verification of the tumor. However, taking into account the location of the parathyroid glands, it is not always possible (difficult ultrasound control) and, in most cases, is inappropriate (there is a risk of spread of metastases due to damage to the capsule of the gland).
To detect metastases in distant organs, ultrasound, radiography, CT, MRI, scintigraphy, and other methods are used.
Treatment of parathyroid gland cancer
A comprehensive examination objectively assesses the clinical situation and selects the optimal treatment tactics. The first stage always consists of surgery, during which the tumor is removed. The intervention may be supplemented by conservative measures to eliminate residual atypical cells.
Conservative treatment
Therapeutic measures are carried out after surgery. In the complex treatment of parathyroid cancer, chemotherapy, and radioactive iodine treatment are used. Insufficiency of the parathyroid gland is compensated with vitamin D and calcium preparations. If necessary, thyroid hormone replacement therapy is prescribed.
Surgical treatment
Surgery for parathyroid cancer involves its total removal within healthy tissue, while it is important not to damage its capsule. If the tumor invades the thyroid gland, the corresponding lobe and isthmus are removed (in some cases, it is necessary to remove the entire organ). If necessary, the operation is supplemented with lymph node dissection.
All these treatment options are available in more than 350 hospitals worldwide (https://doctor.global/results/diseases/parathyroid-tumor). For example, parathyroidectomy is performed in 14 clinics across Turkey for an approximate price of $3.6 K (https://doctor.global/results/asia/turkey/all-cities/all-specializations/procedures/parathyroidectomy).
Prevention
Prevention of parathyroid cancer involves careful monitoring of the state of the organ in the presence of predisposing pathologies. Annual thyroid gland ultrasound allows timely detection of pathological changes in the structure of the parathyroid glands. General prevention involves nutrition and correction of deficiency states.
Rehabilitation after surgical treatment
Interventions on the parathyroid glands are performed openly. After the surgical stage, if necessary, chemotherapy is prescribed. Inpatient observation lasts 2-5 days. After two weeks, the patient can return to the usual way of life.
Advancements in Treatment
Recent advancements in surgical techniques, including minimally invasive procedures guided by intraoperative PTH monitoring, have significantly improved outcomes for patients with parathyroid tumors.
Living with Parathyroid Tumors
Managing a parathyroid tumor involves ongoing monitoring of calcium levels, adhering to treatment plans, and maintaining a healthy lifestyle to support bone health.
Conclusion
Parathyroid tumors, while predominantly benign, can lead to significant health issues due to their effect on calcium regulation. Advances in diagnostic methods and treatment options have greatly improved the prognosis for affected individuals. Early detection and appropriate management are key to preventing complications and ensuring a high quality of life for those diagnosed with parathyroid tumors.
